13 - Dermatology 2: Inflammatory and immunological skin disease Flashcards
What are examples of inflammatory skin disease?
- eczema
- occupational dermatitis
- psoriasis
What is eczema?
- inflammation of the skin that presents with itchiness, dryness and becomes flaky
- can occasionally weep
- two common types atopic and contact
- affects flexor surfaces and trunk primarily
What are common sites of eczema?
- face
- neck
- elbows
- wrists
- groin
- knees
- ankles
What is atopic eczema?
- most common
- develops in childhood and usually improves with age
- FH
- associated with other atopic conditions (ie hayfever and asthma)
What are the other types of eczema?
- atopic
- contact
- seborrhoeic
- discoid
- gravitational
What is contact eczema?
- occurs when there is contact with an allergen
- most likely onset during adulthood
What is seborrhoeic eczema?
- scalp and eye lashes
- appears as severe form of dandruff
What is discoid eczema?
Appears as circular patches on body
What is gravitational eczema?
Related to poor circulation in legs
How do you manage eczema?
- cotton clothing (breathable)
- emollients (prevent drying of irritated skin, traps moisture in skin after bathing)
- soap substitutes
- corticosteroids (topical, acute management of inflammation)
What is occupational dermatitis?
- also known as contact dermatitis
- reaction to environmental agent
- present with rash, can blister or come out in hives
- presents either immediately or within 72 hours
- intense itch
What is the management of occupational dermatitis?
- remove source (can be identified using spot test )
- topical steroid can treat acute symptoms
What is psoriasis?
- inflammatory skin disease of unknown origin
- dysregulated epidermal proliferation, new cells are produced quicker than old cells lost
- results in surface build up and thickening
- typically affects extensor surfaces of limbs and trunk
- can be associated with severe arthritis (psoriatic arthropathy)
- presents with red scaly patches that itch
- FH
How do you manage psoriasis?
Topical
- emollients
- topical steroids
- tar (like soap bar)
- dithranol cream
- vitamin A derivatives
- PUVA (UV activated topical drug)
Systemic
- drugs that reduce turnover (methotrexate, cyclosporin, infliximab)
What are examples of immunological skin diseases?
- pemphigoid
- pemphigus
- epidermolysis bullosa
- lichen planus
- scleroderma
- dermatomyositis
- raynauds
What is immunological skin disease?
- auto-antibody attack on skin components causing loss of cell-cell adhesion
- split forms within skin which fills with inflammatory exudate and forms vesicle or blister
What is pemphigoid?
- blistering condition
- sub-epithelial antibody attack
- thick walled blister (epidermis is intact) filled with clear liquid or blood
- different presentations include bullous, mucous membrane and cicatrital
How does pemphigoid affect the mouth?
- mucous membrane pemphigoid is most communion the mouth
- scarring can result
How do you manage pemphigoid?
Manage with immunosuppressants (either steroids or steroid-sparing drugs eg methotrexate)
What is pemphigus?
- auto-antibody attack on epidermis
- affects mucosa and skin, commonly seen first in the mouth
- presents with blisters and surface is easily lost
- fatal if left untreated or associated with complications of treatment
What is epidermolysis bullosa?
- group of genetic conditions
- some mild conditions appear later in life
- some incompatible with life, stillborn or death shortly after birth
What are the different types of epidermolysis bullosa?
- EB simplex
- junctional EB
- dystrophic EB
- EB acquisita
What problems are associated with epidemolysis bullosa?
- infection
- fluid loss
- scarring
How do you manage epidermolysis bullosa?
- no cure
- treatment is based on relieving symptoms
